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1.
; Brasil.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-47008

RESUMO

O fórum de dois dias foi realizado em linha com o Projeto de Pesquisa e Desenvolvimento da OMS – uma estratégia para desenvolver medicamentos e vacinas antes de as epidemias ocorrem, além de acelerar a pesquisa e o desenvolvimento enquanto elas ocorrem.


Assuntos
Prioridades em Saúde , Coronavirus , Pesquisas sobre Serviços de Saúde/métodos
2.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 19-25, feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-3432

RESUMO

Objetivo. La correcta identificación en el primer contacto médico de los pacientes con un síndrome coronario agudo (SCA) es esencial. No existe ninguna escala predictiva para el diagnóstico de SCA en los centros de coordinación de emergencias (CCE) que facilite la toma de decisiones al equipo médico. El objetivo primario es construir y validar una escala de estas características. Método. Estudio prospectivo, observacional, unicéntrico, realizado durante 1 año (2016). Se incluyeron los pacientes que consultaron telefónicamente por dolor torácico no traumático en un CCE. Los pacientes incluidos se repartieron en las muestras de derivación y validación de forma aleatoria. La escala predictiva –escala SCARE– se construyó mediante regresión logística, la discriminación y calibración del modelo se realizó con el cálculo del área bajo la curva (ABC) de la característica operativa del receptor y el test de Hosmer-Lemeshow. Resultado. La muestra de derivación incluyó 902 pacientes y 7 de las variables recogidas se relacionaron con un diagnóstico final de SCA: sexo masculino, edad, tabaquismo, dolor torácico de características típicas, primer episodio de dolor torácico, diaforesis y la intuición del médico que realizó la entrevista telefónica. La utilización de la escala desarrollada en los 465 pacientes de la muestra de validación obtuvo un ABC de 0,81 (intervalo de confianza al 95% 0,76-0,87) y el test de Hosmer-Lemeshow fue de 5,18 (p = 0,74). Conclusión. La escala SCARE mostró una correcta discriminación y calibración. Es necesaria una validación externa multicéntrica antes de implementar su uso en los CCE


Background and objective. Correctly identifying patients with acute coronary syndrome (ACS) on first contact is essential, yet emergency dispatchers currently lack a risk scale that can help predict an ACS diagnosis. Our main aim was to develop and validate such a risk scale. Methods. Prospective, observational single-center study in 2016 (January 1 to December 31). We included patients who called our emergency dispatch center to report nontraumatic chest pain. Included patients were randomly assigned to a development or a validation sample. The predictive SCARE scale was built with logistic regression analysis. Discrimination and calibration were analyzed by calculating the area under the receiver operating characteristic curve; calibration was assessed with the Hosmer-Lemeshow test. Results. The development sample included 902 patients. The regression model identified 7 variables associated with a final diagnosis of ACS: male sex, age, smoking, typical pain characteristics, first episode of chest pain, diaphoresis, and physician intuition (the teledispatcher’s suspicion). When we applied the scale in the validation sample of 465 patients the area under the curve was 0.81 (95% CI, 0.76-0.87). The Hosmer-Lemeshow statistic was 5.18 (P=.74). Conclusions. The SCARE scale had good discrimination and calibration properties. The scale should be further validated in an external sample from a multicenter study before it is implemented by emergency dispatch centers


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/diagnóstico , Serviços Médicos de Emergência/métodos , Técnicas de Apoio para a Decisão , Dor no Peito/diagnóstico , Estudos Prospectivos , Valor Preditivo dos Testes , Telefone/estatística & dados numéricos , Modelos Logísticos , Intuição , Inquéritos e Questionários
3.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 45-48, feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-3436

RESUMO

Objetivo. Evaluar los resultados de la formación mixta frente a la presencial en un curso de soporte vital básico/desfibrilador externo automático (SVB/DEA), así como su retención a los 9 meses. Método. Estudio experimental aleatorizado que compara los resultados de la formación en SVB/DEA entre un grupo control (GC) que recibió formación presencial de 4 horas frente a un grupo experimental (GE) que recibió formación en metodología mixta: 2 horas virtuales y 2 horas presenciales. Resultados. Participaron 89 alumnos (45 del GC y 44 del GE). Después de la formación, el GC obtuvo mejores puntuaciones en conocimientos [8,6 (DE 0,9) frente a 8,0 (DE 1,14), p = 0,013]. El GE obtuvo mejores puntuaciones en las habilidades del tiempo en segundos de "hands off" y en el porcentaje de la rexpansión completa del tórax. Los conocimientos decaen a los 9 meses, pero sin diferencias entre los dos grupos. La retención global baja de 8,31 (DE 1,1) a 6,04 (DE 1,6) (p = 0,001), en 9 meses, pero de forma similar en ambos grupos. En las habilidades prácticas no hubo diferencias entre los dos grupos ni al finalizar el curso ni a los 9 meses. Conclusiones. Con la metodología virtual se obtienen mejores resultados en algunos parámetros de las habilidades


Objective. To evaluate the immediate and 9-month results of blended versus standard training in basic life support and the use of an automatic external defibrillator (BLS/AED). Methods. Randomized trial comparing the results of standard BLS/AED training to blended training. The control group received 4 hours of standard instruction from a trainer and the experimental blended-training group received 2 hours of virtual training and 2 hours of in-person instruction. Results. Eighty-nine students participated, 45 in the control group and 44 in the experimental group. The controls achieved better mean (SD) knowledge scores immediately after training (8.6 [0.9] vs 8.0 [1.14] in the experimental group, P=.013). The blended training group scored better on certain skill markers (hands-off time in seconds and compressions followed by complete chest recoil). Participant knowledge had decreased at 9 months without significant between-group differences. Overall, retention fell from a score of 8.31 (1.1) to 6.04 (1.6) (P=.001) in 9 months and the loss was similar in the 2 groups. No differences in practical skills between the groups were observed at the end of the course or 9 months later. Conclusions. The blended training method led to better results on some skill ítems


Assuntos
Humanos , Feminino , Adulto , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Sociedades Médicas/normas , Reanimação Cardiopulmonar/educação , Parada Cardíaca , Índice de Massa Corporal
4.
Int J Oral Sci ; 12(1): 5, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32024813

RESUMO

Rheumatoid arthritis (RA) is an autoimmune disease affecting 1% of the world population and is characterized by chronic inflammation of the joints sometimes accompanied by extra-articular manifestations. K/BxN mice, originally described in 1996 as a model of polyarthritis, exhibit knee joint alterations. The aim of this study was to describe temporomandibular joint (TMJ) inflammation and damage in these mice. We used relevant imaging modalities, such as micro-magnetic resonance imaging (µMRI) and micro-computed tomography (µCT), as well as histology and immunofluorescence techniques to detect TMJ alterations in this mouse model. Histology and immunofluorescence for Col-I, Col-II, and aggrecan showed cartilage damage in the TMJ of K/BxN animals, which was also evidenced by µCT but was less pronounced than that seen in the knee joints. µMRI observations suggested an increased volume of the upper articular cavity, an indicator of an inflammatory process. Fibroblast-like synoviocytes (FLSs) isolated from the TMJ of K/BxN mice secreted inflammatory cytokines (IL-6 and IL-1ß) and expressed degradative mediators such as matrix metalloproteinases (MMPs). K/BxN mice represent an attractive model for describing and investigating spontaneous damage to the TMJ, a painful disorder in humans with an etiology that is still poorly understood.


Assuntos
Artrite Experimental/patologia , Artrite Reumatoide/patologia , Osso e Ossos/diagnóstico por imagem , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/lesões , Microtomografia por Raio-X/métodos , Animais , Artrite Experimental/imunologia , Artrite Reumatoide/imunologia , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Modelos Animais de Doenças , Humanos , Imagem por Ressonância Magnética , Metaloproteinase 8 da Matriz/imunologia , Camundongos , Camundongos Transgênicos , Articulação Temporomandibular/metabolismo , Tomografia Computadorizada por Raios X
5.
Adv Exp Med Biol ; 1213: 23-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030661

RESUMO

Medical images have been widely used in clinics, providing visual representations of under-skin tissues in human body. By applying different imaging protocols, diverse modalities of medical images with unique characteristics of visualization can be produced. Considering the cost of scanning high-quality single modality images or homogeneous multiple modalities of images, medical image synthesis methods have been extensively explored for clinical applications. Among them, deep learning approaches, especially convolutional neural networks (CNNs) and generative adversarial networks (GANs), have rapidly become dominating for medical image synthesis in recent years. In this chapter, based on a general review of the medical image synthesis methods, we will focus on introducing typical CNNs and GANs models for medical image synthesis. Especially, we will elaborate our recent work about low-dose to high-dose PET image synthesis, and cross-modality MR image synthesis, using these models.


Assuntos
Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Humanos
6.
Adv Exp Med Biol ; 1213: 59-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030663

RESUMO

For computer-aided diagnosis (CAD), detection, segmentation, and classification from medical imagery are three key components to efficiently assist physicians for accurate diagnosis. In this chapter, a completely integrated CAD system based on deep learning is presented to diagnose breast lesions from digital X-ray mammograms involving detection, segmentation, and classification. To automatically detect breast lesions from mammograms, a regional deep learning approach called You-Only-Look-Once (YOLO) is used. To segment breast lesions, full resolution convolutional network (FrCN), a novel segmentation model of deep network, is implemented and used. Finally, three conventional deep learning models including regular feedforward CNN, ResNet-50, and InceptionResNet-V2 are separately adopted and used to classify or recognize the detected and segmented breast lesion as either benign or malignant. To evaluate the integrated CAD system for detection, segmentation, and classification, the publicly available and annotated INbreast database is used over fivefold cross-validation tests. The evaluation results of the YOLO-based detection achieved detection accuracy of 97.27%, Matthews's correlation coefficient (MCC) of 93.93%, and F1-score of 98.02%. Moreover, the results of the breast lesion segmentation via FrCN achieved an overall accuracy of 92.97%, MCC of 85.93%, Dice (F1-score) of 92.69%, and Jaccard similarity coefficient of 86.37%. The detected and segmented breast lesions are classified via CNN, ResNet-50, and InceptionResNet-V2 achieving an average overall accuracies of 88.74%, 92.56%, and 95.32%, respectively. The performance evaluation results through all stages of detection, segmentation, and classification show that the integrated CAD system outperforms the latest conventional deep learning methodologies. We conclude that our CAD system could be used to assist radiologists over all stages of detection, segmentation, and classification for diagnosis of breast lesions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Aprendizado Profundo , Diagnóstico por Computador , Interpretação de Imagem Assistida por Computador , Mamografia/métodos , Humanos
7.
Adv Exp Med Biol ; 1213: 135-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030668

RESUMO

This chapter focuses on modern deep learning techniques that are proposed for automatically recognizing and segmenting multiple organ regions on three-dimensional (3D) computed tomography (CT) images. CT images are widely used to visualize 3D anatomical structures composed of multiple organ regions inside the human body in clinical medicine. Automatic recognition and segmentation of multiple organs on CT images is a fundamental processing step of computer-aided diagnosis, surgery, and radiation therapy systems, which aim to achieve precision and personalized medicines. In this chapter, we introduce our recent works on addressing the issue of multiple organ segmentation on 3D CT images by using deep learning, a completely novel approach, instead of conventional segmentation methods originated from traditional digital image processing techniques. We evaluated and compared the segmentation performances of two different deep learning approaches based on 2D- and 3D deep convolutional neural networks (CNNs) without and with a pre-processing step. A conventional method based on a probabilistic atlas algorithm, which presented the best performance within the conventional approaches, was also adopted as a baseline for performance comparison. A dataset containing 240 CT scans of different portions of human bodies was used for training the CNNs and validating the segmentation performance of the learning results. A maximum number of 17 types of organ regions in each CT scan were segmented automatically and validated with the human annotations by using ratio of intersection over union (IoU) as the criterion. Our experimental results showed that the IoUs of the segmentation results had a mean value of 79% and 67% by averaging 17 types of organs that were segmented by the proposed 3D and 2D deep CNNs, respectively. All results using the deep learning approaches showed better accuracy and robustness than the conventional segmentation method that used the probabilistic atlas algorithm. The effectiveness and usefulness of deep learning approaches were demonstrated for multiple organ segmentation on 3D CT images.


Assuntos
Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos
8.
Adv Exp Med Biol ; 1213: 165-176, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030670

RESUMO

Advancements in musculoskeletal analysis have been achieved by adopting deep learning technology in image recognition and analysis. Unlike musculoskeletal modeling based on computational anatomy, deep learning-based methods can obtain muscle information automatically. Through analysis of image features, both approaches can obtain muscle characteristics such as shape, volume, and area, and derive additional information by analyzing other image textures. In this chapter, we first discuss the necessity of musculoskeletal analysis and the required image processing technology. Then, the limitations of skeletal muscle recognition based on conventional handcrafted features are discussed, and developments in skeletal muscle recognition using machine learning and deep learning technology are described. Next, a technique for analyzing musculoskeletal systems using whole-body computed tomography (CT) images is shown. This study aims to achieve automatic recognition of skeletal muscles throughout the body and automatic classification of atrophic muscular disease using only image features, to demonstrate an application of whole-body musculoskeletal analysis driven by deep learning. Finally, we discuss future development of musculoskeletal analysis that effectively combines deep learning with handcrafted feature-based modeling techniques.


Assuntos
Osso e Ossos/diagnóstico por imagem , Aprendizado Profundo , Interpretação de Imagem Assistida por Computador , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos
9.
Bone Joint J ; 102-B(2): 246-253, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009423

RESUMO

AIMS: To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). METHODS: All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up. RESULTS: All patients demonstrated statistically significant improvement in all functional outcomes and active shoulder abduction and external rotation ROM (p < 0.001). Patients < 2.5 years of age had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto scores (p ≤ 0.035) compared to patients ≥ 2.5 years old. There were 17 patients (16%) who required a subsequent humeral derotational osteotomy; lower preoperative AMS external rotation scores and external rotation ROM were predictive risk factors (p ≤ 0.016). CONCLUSION: Patients with BPBP who underwent the Hoffer procedure demonstrated significant improvement in postoperative ROM, strength, and functional outcome scores at mid-term follow-up. Patients younger than 2.5 years at the time of surgery generally had better functional outcomes. Limited preoperative external rotation strength and ROM were significantly associated with requirement for subsequent humeral derotational osteotomy. In our chort significant improvements in shoulder function were obtained after the Hoffer procedure for BPBP. Cite this article: Bone Joint J 2020;102-B(2):246-253.


Assuntos
Plexo Braquial/cirurgia , Paralisia do Plexo Braquial Neonatal/cirurgia , Transferência Tendinosa/métodos , Adolescente , Plexo Braquial/lesões , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Paralisia do Plexo Braquial Neonatal/reabilitação , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Articulação do Ombro/fisiopatologia , Transferência Tendinosa/reabilitação , Resultado do Tratamento
10.
Bone Joint J ; 102-B(2): 205-211, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009424

RESUMO

AIMS: To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. METHODS: A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls. RESULTS: Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides. CONCLUSION: The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205-211.


Assuntos
Articulação do Tornozelo/fisiopatologia , Tornozelo/fisiopatologia , Pé/fisiopatologia , Ligamentos Articulares/fisiopatologia , Tendões/transplante , Sítio Doador de Transplante/fisiopatologia , Adulto , Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Pé/diagnóstico por imagem , Humanos , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Regeneração , Estudos Retrospectivos , Transferência Tendinosa , Tendões/diagnóstico por imagem , Tendões/fisiologia , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/reabilitação , Sítio Doador de Transplante/diagnóstico por imagem , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
11.
Bone Joint J ; 102-B(2): 177-185, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009426

RESUMO

AIMS: To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs). METHODS: This is a retrospective cohort study of patients with GCT who presented between January 2011 and July 2017. Intralesional curettage was performed and patients treated from 2015 to 2017 also received denosumab therapy. The patients were divided into three groups: Cohort 1: control group (n = 36); cohort 2: adjuvant denosumab group (n = 9); and cohort 3: neo- and adjuvant-denosumab group (n = 17). RESULTS: There were 68 patients within the study period. Six patients were lost to follow-up. The mean follow-up was 47.7 months (SD 23.2). Preoperative denosumab was found to reduce intraoperative haemorrhage and was associated with shorter operating time for tumour volume > 200 cm3. A total of 17 patients (27.4%) developed local recurrence. The locoregional control rate was 77.8% (7/9) and 87.5% (14/16) respectively for cohorts 2 and 3, in comparison to 66.7% (24/36) of the control group. The recurrence-free survival (RFS) rate was significantly higher for adjuvant denosumab group versus those without adjuvant denosumab during the first two years: 100% vs 83.8% at one year and 95.0% vs 70.3% at two years. No significant difference was found for the three-year RFS rate. CONCLUSION: Preoperative denosumab therapy was found to reduce intraoperative haemorrhage and was associated with shorter operating times. Adjuvant denosumab was useful to prevent early recurrence during the first two years after surgery. Cite this article: Bone Joint J 2020;102-B(2):177-185.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/cirurgia , Denosumab/uso terapêutico , Tumor de Células Gigantes do Osso/cirurgia , Sacro/cirurgia , Adolescente , Adulto , Neoplasias Ósseas/tratamento farmacológico , Criança , Terapia Combinada , Curetagem/métodos , Feminino , Tumor de Células Gigantes do Osso/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Bone Joint J ; 102-B(2): 198-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009433

RESUMO

AIMS: This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. METHODS: Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register. RESULTS: Among patients with possible follow-up of ten and 15 years, 152 and 72 patients remained alive without revision of the acetabular component. The number of deaths was 61 and 50, respectively. Of those who died, six patients in each group had a reoperation performed before death. The number of patients with a reoperation was 22 for those with ten-year follow-up and 21 for those with 15 years of follow-up. The Kaplan-Meier implant survival rate for aseptic loosening among all 370 patients in the cohort was 96.3% (95% confidence interval (CI) 94.1 to 98.5) after ten years and 92.8% (95% CI 89.2 to 96.6) after 15 years. CONCLUSION: Extensive bone impaction grafting combined with uncemented revision components appears to be a reliable method with favourable long-term survival. This technique offers the advantage of bone stock restoration and disputes the long-standing perception that uncemented components require > 50% of host bone contact for successful implant survival. Cite this article: Bone Joint J 2020;102-B(2):198-204.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Transplante Ósseo/métodos , Prótese de Quadril , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Sistema de Registros , Reoperação
13.
Bone Joint J ; 102-B(2): 239-245, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009437

RESUMO

AIMS: Anterior cruciate ligament (ACL) surgery in children and the adolescent population has increased steadily over recent years. We used a national database to look at trends in ACL reconstruction and rates of serious complications, growth disturbance, and revision surgery, over 20 years. METHODS: All hospital episodes for patients undergoing ACL reconstruction, under the age of 20 years, between 1 April 1997 and 31 March 2017, were extracted by procedure code from the national Hospital Episode Statistics (HES). Population standardized rates of intervention were determined by age group and year of treatment. Subsequent rates of serious complications including reoperation for infection, growth disturbance (osteotomy, epiphysiodesis), revision reconstruction, and/or contralateral ACL reconstruction rates were determined. RESULTS: Over the 20 year period, 16,125 ACL reconstructions were included. The mean age of patients was 16.9 years (SD 2.0; 27.1% female, n = 4,374/16,125). The majority of procedures were observed in the 15 to 19 years age group. The rate of ACL reconstruction increased 29-fold from 1997 to 1998, to 2016 to 2017. Within 90 days of ACL reconstruction, the rate of reoperation for infection was 0.31% (95% confidence interval (CI) 0.23 to 0.41, n = 50/16,125) and the rate of pulmonary embolism was 0.037% (95%.CI 0.014 to 0.081, n = 6/16,125). Of those with minimum five-year follow-up following ACL reconstruction (n = 7,585), 1.00% of patients subsequently underwent an osteotomy (95% CI 0.79 to 1.25, n = 76/7,585), 0.09% an epiphysiodesis (95% CI 0.04 to 0.19, n = 7/7,585), 7.46% revision ACL reconstruction (95% CI 6.88 to 8.08, n = 566/7,585), and 6.37% contralateral ACL reconstruction (95% CI 5.83 to 6.94, n = 483/7,585). CONCLUSION: Rates of paediatric and adolescent ACL reconstruction have increased 29-fold over the last 20 years. Despite the increasing rate in the younger population, the risk of serious complications, including further surgery for growth disturbance is very low. The results of our study provide a point of reference for shared decision making in the management of ACL injury in the paediatric and adolescent population. Cite this article: Bone Joint J 2020;102-B(2):239-245.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Adolescente , Lesões do Ligamento Cruzado Anterior/epidemiologia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Reoperação/estatística & dados numéricos , Reino Unido/epidemiologia , Adulto Jovem
14.
Bone Joint J ; 102-B(2): 155-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009440

RESUMO

AIMS: Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. METHODS: We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). RESULTS: The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d'Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. CONCLUSION: The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155-161.


Assuntos
Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Idoso Fragilizado , Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Comores , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suporte de Carga
15.
Bone Joint J ; 102-B(2): 261-267, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009441

RESUMO

AIMS: It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis. METHODS: In all, 91 nonambulatory patients with neuromuscular scoliosis were included. All underwent surgery using bilateral, segmental, pedicle screw instrumentation. A total of 40 patients underwent fusion to L5 and 51 had their fixation extended to the pelvis. The two groups were assessed for differences in terms of clinical and radiological findings, as well as complications. RESULTS: The main curve (MC) was a mean of 90° (40° to 141°) preoperatively and 46° (15° to 82°) at two-year follow-up in the L5 group, and 82° (33° to 116°) and 19° (1° to 60°) in the pelvic group (p < 0.001 at follow-up). Correction of MC and pelvic obliquity (POB) were statistically greater in the pelvic group (p < 0.001). There was no statistically significant difference in the operating time, blood loss, or complications. Loss of MC correction (> 10°) was more common in patients fixated to the pelvis (23% vs 3%; p = 0.032), while loss of pelvic obliquity correction was more frequent in the L5 group (25% vs 0%; p = 0.007). Risk factors for loss of correction (either POB or MC) included preoperative coronal imbalance (> 50 mm, odds ratio (OR) 11.5, 95%confidence interval (CI) 2.0 to 65; p = 0.006) and postoperative sagittal imbalance (> 25 mm, OR 11.0, 95% CI1.9 to 65; p = 0.008). CONCLUSION: We found that patients undergoing pelvic fixation had a greater correction of MC and POB. The rate of complications was not different. Preoperative coronal and postoperative sagittal imbalance were associated with increased risks of loss of correction, regardless of extent of fixation. Therefore, we recommend pelvic fixation in all nonambulatory children with neuromuscular scoliosis where coronal or sagittal imbalance are present preoperatively. Cite this article: Bone Joint J 2020;102-B(2):261-267.


Assuntos
Vértebras Lombares/cirurgia , Sacro/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Limitação da Mobilidade , Parafusos Pediculares , Estudos Retrospectivos , Escoliose/complicações , Fusão Vertebral/instrumentação , Resultado do Tratamento
16.
Rev Med Suisse ; 16(680): 260-263, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022490

RESUMO

International guidelines suggest that a liberal transfusion policy is not only unnecessary but can also prove harmful in certain situations. Blood transfusion is a costly act involving risks of infection, allergic and hemodynamic. Optimizing the use of this scarce and expensive resource becomes necessary. The case report depicts perfectly the potential complications of a transfusion policy considered too liberal, while emphasizing the importance of clinical judgment in each situation.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/normas , Transfusão de Eritrócitos/métodos , Humanos
17.
Instr Course Lect ; 69: 3-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017714

RESUMO

The goal of this chapter is to describe the extensile femoral exposure options and femoral revision techniques using the direct anterior approach (DAA) in total hip arthroplasty. Although DAA is initially described as a muscle-sparing exposure for primary hip arthroplasty, because of its internervous anatomic dissection, the internervous and intermuscular benefits of the DAA are maintained throughout the revision exposure. This distinguishing feature of the DAA must be respected to promote maximal muscle function and stability following revision surgery. Femoral revision exposure can be challenging through any surgical approach. The direct anterior exposure provides a unique access angle to the femur and therefore the incision, releases, osteotomies, and stem insertion techniques differ in many respects from more traditional exposures. The authors hope that this chapter will expose surgeons to the cascade of revision anterior femoral exposure and demonstrate the key elements for successful revision surgery.


Assuntos
Artroplastia de Quadril/métodos , Fêmur , Humanos , Reoperação
18.
Zhonghua Yi Xue Za Zhi ; 100(3): 172-177, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008281

RESUMO

Objective: To analyze the pattern of the change in cerebral white matter tract in amnestic mild cognitive impairment (aMCI) patients based on the automating fiber-tract quantification (AFQ). Methods: A total of 20 aMCI patients,9 males,11 females, the mean age was (67±9) years, and 22 patients with naMCI, 8 males,14 females, the mean age was (64±10) years, and 23 normal control subjects, 10 males, 13 females, with a mean age of (65±9) years were enrolled from the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2018 to March 2019. All of them underwent 3.0 T MRI scan, which include DTI and 3D T(1)WI sequence.Two tract profiles, fractional anisotropy (FA) and mean diffusivity (MD), were extracted to evaluate the white matter integrity at 100 locations along each of 20 fiber tracts based on the AFQ. Results: In a pointwise comparison of FA profiles,the aMCI patients showed FA reduction in the middle part of right corticospinal tract (t=-4.023, P<0.01, FWE corrected) relative to the naMCI patients. There was a positive correlation between the decreased FA value and the auditory verbal learning test score (P=0.039). In a pointwise comparison of MD profiles, the aMCI patients showed extensive MD elevation in the middle part of the left cingulum hippocampus (t=2.408,P=0.037,FWE corrected) relative to the naMCI patients. The aMCI patients showed MD elevation in the posterior part of the left inferior longitudinal fasciculus (t=-2.919, P=0.006, FWE corrected) and the middle part of the left cingulum hippocampus (t=-3.878, P=0.002, FWE corrected) relative to the NC subjects. And the elevated MD in left inferior longitudinal fasciculus showed negative correlation with MoCA (P=0.039) and auditory verbal learning test score (P=0.015). There was also a negative correlation between the elevated MD value in the left cingulum hippocampus and the auditory verbal learning test score (P=0.033). Conclusions: Disruption is found in specific part along the white matter tract in the aMCI group. Furthermore, the pattern of white matter abnormalities is different across neuronal fiber tracts. These findings will have an impact on the further specific study of the white matter tract in aMCI patients.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Disfunção Cognitiva , Imagem de Tensor de Difusão/métodos , Fibras Nervosas/patologia , Substância Branca/diagnóstico por imagem , Idoso , Anisotropia , Encéfalo , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Substância Branca/patologia
19.
Zhonghua Yi Xue Za Zhi ; 100(3): 178-181, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008282

RESUMO

Objective: To evaluate the classification of the types of pediatric posterior fossa brain tumors based on routine MRI (T(1)WI, T(2)WI and ADC) using wavelet transformation analysis of whole tumor. Methods: MRI images of medulloblastoma (n=59), ependymoma (n=13) and pilocytic astrocytoma (n=27) confirmed by pathology before treatments in Children's Hospital of Nanjing Medical University from January 2014 to February 2019 were enrolled in this retrospective study as well as the clinical data of age, gender and symptoms. Registration was performed among the three sequences and wavelet features of ROI were acquired. Afterwards, the top ten features were ranked and trained among groups by using random forest classifier. Finally, the results were compared and analyzed according to the classification. Results: The top ten contribution three sequences and wavelet features of ROI were acquired from the ADC sequence. The random forest classifier achieved 100% accuracy on training data and was validated best accuracy (86.8%) when combined of first and third wavelet features. The sensitivity was 100%, 94.8%, 76.9%, and the specificity was 97.6%, 88.0%, 98.8% respectively. Conclusions: Features based on wavelet transformation of ADC sequence of entire tumor can provide more quantitative information, which could provide help in the differential diagnosis of pediatric posterior fossa brain tumors. The optimum combination to distinguish three pediatric posterior fossa brain tumors is sixth and twelfth wavelet features of ADC sequence.


Assuntos
Astrocitoma/classificação , Neoplasias Cerebelares/patologia , Neoplasias Infratentoriais/patologia , Imagem por Ressonância Magnética/métodos , Meduloblastoma/classificação , Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Criança , Humanos , Meduloblastoma/patologia , Estudos Retrospectivos
20.
Zhonghua Yi Xue Za Zhi ; 100(3): 182-186, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008283

RESUMO

Objective: To analyze morphological changes in central sulcus of the cerebral cortex in children with complete growth hormone deficiency (CGHD). Methods: Patients attending the Shandong Provincial Hospital who were diagnosed with CGHD or idiopathic short stature were recruited from January 2015 to January 2019. Thirty children with CGHD (18 males and 12 females, 5 to 14 years old) and 30 children with idiopathic short stature (22 males and 8 females, 5 to 14 years old) were included. Measurements of the central sulcus, including the average width, maximum depth, average depth, top length, bottom length and depth position-based profiles (DPP), were obtained using Brain VISA software. The significant differences between groups were statistically analyzed. Results: The average width of bilateral central sulci in children with CGHD (left: (2.26±0.41) mm; right: (2.19±0.34) mm) were significantly higher than those in children with idiopathic short stature (left: (2.10±0.27) mm; right: (2.02±0.18) mm) (P<0.05) ; The maximum depth of the left central sulcus ((19.67±1.29) mm) and the average depth of the right central sulcus ((14.18±1.41) mm) were significantly lower than those in children with idiopathic short stature (left maximum depth: (20.69±1.43) mm; right average depth: (14.92±1.21) mm) (P<0.05) . Children with CGHD had significantly lower DPP at the middle part of the left central sulcus (sites: 46-54) and the inferior part of the right central sulcus(sites: 91-98). Conclusion: There are significant morphological changes of the central sulcus in children with CGHD, which may represent the structural basis of their relatively slower development in motor, cognitive and linguistic functional performance.


Assuntos
Encéfalo/patologia , Córtex Cerebral/anatomia & histologia , Hormônio do Crescimento/deficiência , Imagem por Ressonância Magnética/métodos , Adolescente , Encéfalo/fisiopatologia , Mapeamento Encefálico , Criança , Pré-Escolar , Feminino , Humanos , Masculino
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